Kuschel C, Evans N, Lam A
Department of Neonatal Medicine, Royal Prince Alfred Hospital, NSW, Australia.
Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F199-203. doi: 10.1136/fn.78.3.f199.
To evaluate factors predictive of individual response to dexamethasone in preterm infants.
A cohort of 74 preterm infants born between January 1993 and February 1996 was studied retrospectively. All of them had received dexamethasone to facilitate weaning from artificial ventilation. Demographic factors, ventilation parameters, and details of dexamethasone administration were recorded from the medical and nursing notes. Radiographs were assessed by one observer who was unaware of the clinical condition of the infant or the outcome. Outcome variables examined included change in ventilation index (VI) at 36-48 hours, the number of days to extubation from the start of dexamethasone, and death before extubation.
Most babies improved but changes in VI at 36-48 hours ranged from substantial deterioration to dramatic improvement. No identifiable factors were significantly associated with this range of response. The median time to extubation was 6 days. The 36 babies who extubated within the first 6 days were: significantly more mature; less likely to have pulmonary interstitial emphysema (PIE) or pneumothorax; and had significantly lower VIs in the 12 hours preceding dexamethasone treatment. The postconceptional age at extubation was the same whether babies were extubated within or after the first 6 days. Multiple linear regression confirmed a significant association between number of days to extubation and the three factors described above (adjusted R2 = 0.5126).
Individual responses to dexamethasone can be partly predicted by gestation, the presence of PIE, and the VI before dexamethasone administration.
评估早产儿对地塞米松个体反应的预测因素。
对1993年1月至1996年2月间出生的74例早产儿进行回顾性研究。所有患儿均接受地塞米松治疗以促进撤机。从医疗和护理记录中记录人口统计学因素、通气参数及地塞米松给药细节。由一名对婴儿临床状况及预后不知情的观察者评估X光片。所检查的结局变量包括36 - 48小时时通气指数（VI）的变化、从开始使用地塞米松至拔管的天数以及拔管前死亡情况。
多数婴儿病情改善，但36 - 48小时时VI的变化范围从显著恶化到显著改善。未发现可识别因素与该反应范围有显著关联。拔管的中位时间为6天。在头6天内拔管的36例婴儿：胎龄显著更大；发生肺间质气肿（PIE）或气胸的可能性更小；且在使用地塞米松治疗前12小时的VI显著更低。无论婴儿在头6天内还是之后拔管，拔管时的孕龄相同。多元线性回归证实拔管天数与上述三个因素之间存在显著关联（调整后的R2 = 0.5126）。
对地塞米松的个体反应可部分通过孕周、PIE的存在情况以及使用地塞米松前的VI来预测。
